Lower Extremity Musculoskeletal Injuries Research Articles

Association Between Running Characteristics and Lower Extremity Musculoskeletal Injuries in United States Military Academy Cadets.

Running-related overuse injuries are common among recreational runners; however, there is currently little prospective research investigating the role of running characteristics on overuse injury development. To investigate the relationship between running characteristics and lower extremity musculoskeletal injury (MSKI). Cohort study; Level of evidence, 2. The study included 827 incoming cadets of the class of 2020 at the United States Military Academy. Before cadet basic training, running spatiotemporal parameters (stride length, ground contact time, and cadence) were recorded for each participant, and foot-strike pattern was analyzed. Demographic data were recorded and analyzed as potential covariates. Lower extremity MSKIs sustained over the 9 weeks of cadet basic training were documented. Kaplan-Meier survival curves were estimated, with time to incident lower extremity MSKI as the primary outcome, by level of the independent predictor variables. Risk factors or potential covariates were carried forward into multivariate Cox proportional hazards regression models. Approximately 18.1% of participants incurred a lower extremity MSKI resulting in ≥3 days of activity limitation during cadet basic training. Univariate analysis indicated that participants with the shortest stride length (<133.0 cm) were 39% more likely to incur any lower extremity MSKI and 45% more likely to incur an overuse MSKI than those with the longest stride length (>158.5 cm), and that participants with the longest ground contact time (>0.42 seconds) were twice as likely to incur any MSKI than those with the shortest contact time (<0.28 seconds). After adjusting for sex, weekly distance running 3 months before cadet basic training, and history of injury, multivariate regression analysis indicated that participants with the longest contact times were significantly more likely to incur overuse lower extremity MSKI than those with the shortest contact times (hazard ratio, 2.15; 95% CI, 1.06-4.37). There was no significant difference in risk of MSKI associated with foot-strike pattern or cadence. Study participants running with the longest ground contact times were 2.15 times more likely to incur an overuse lower extremity MSKI during cadet basic training than those with the shortest contact times. Also, study participants with the shortest stride length were 45% more likely to incur an overuse MSKI than those with the longest stride length.

Novel Use of Exoskeleton Assist Device in an Ankle Fracture: A Case Report.

Lower extremity fractures and musculoskeletal injuries are among the leading causes of morbidity for Special Operations Forces (SOF), frequently resulting in prolonged immobilization and weeks of therapeutic exercises and strength training to return to full status. This is a case of a 34-year-old Caucasian combat rescue officer with a stable right distal fibula (Weber B) fracture managed with early mobilization and assisted plantarflexion using a Dephy Exoboot device. Early mobilization resulted in no adverse events and resulted in a significant reduction in down-time compared with usual care. This case highlights the novel use of a commercially available exoskeleton device to minimize recovery time and speed return to duty for an injured SOF operator. Although further study is required to determine thresholds of safety and applicability, it suggests a potential role for assistive exoskeleton devices in the recovery of injured operators.

Lower Extremity Musculoskeletal Injuries in United States Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016-2021.

Lower Extremity musculoskeletal injuries (LE MSKIs) represent a significant portion of overuse injuries in active duty service members (ADSMs). However, variations in study methods and research gaps related to LE MSKIs have prevented Department of Defense (DoD) leaders from assessing the burden of these conditions. The purpose of this study was to report the incidence, prevalence, and types of LE MSKIs sustained by ADSMs across four branches of service and describe associated health care utilization and private sector costs. This was a retrospective, longitudinal population study, including ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for LE MSKIs, associated health care utilization, and costs were obtained by querying electronic health records (EHR) from military treatment facilities (MTFs), private sector care (PC) claims, and theater medical data from the Military Health System Data Repository (MDR) from October 1, 2015 to September 30, 2021 (FY16-21). Utilization associated with LE MSKIs in both the direct care (DC) and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC costs related to LE MSKIs were captured for each year. In FY21, LE MSKIs occurred in 25.3% of ADSMs (n = 378,615). A higher proportion of females sustained an LE MSKI (33.3%), compared to males (23.7%). From FY16-21, the Army had the highest annual prevalence of LE MSKIs (30.9-35.5%), followed by the Air Force (23.8-31.0%), Marine Corps (23.4-27.0%), and Navy (17.2-19.8%). Incidence rate patterns were similar, with the Army sustaining LE MSKIs at 320 to 377 injuries per 1,000 person-years, followed by the Air Force (241-318), Marines (255-288), and Navy (173-203). Overuse/non-specific MSKIs of the knee were the most common injury type and body region affected, respectively. There were 10,675,543 DC and 1,875,307 PC outpatient encounters from FY16-21 with a primary or secondary diagnosis of LE MSKI. The Air Force was most reliant on PC, with 21.5 to 36.8% of LE MSKI-related encounters occurring outside MTFs during FY16-21. Over $99 million was paid by TRICARE on LE MSKI in FY21 alone with Same Day Surgeries accounting for almost half ($48 million) of this total. Among U.S. ADSMs, LE MSKIs remain highly prevalent and costly. We observed disparities across the Services in the prevalence and incidence of LE MSKIs, and their respective reliance on the private sector for management of these conditions. Findings from this work may support military leaders and MSKI researchers who seek to reduce the impact of LE MSKIs on the readiness and overall health of the U.S. Military.

Track and field-related lower-extremity musculoskeletal injuries: A retrospective study discussing injury analysis, stressors, and comprehensive management

Objective This study aims to provide beneficial information, from a clinical perspective, on how healthcare providers and sports educators can navigate treatment and safety for TAF athletes. This was done by identifying trends seen in lower-extremity TAF injuries and providing potential treatments to counter specific injuries, closing gaps in current literature. Methods The National Electronic Injury Surveillance System (NEISS) database was queried during a ten-year time span (2014-2023) to analyze lower-extremity track and field-related musculoskeletal injuries. Results There were 128,761 cases reported in the Emergency Department from 2014-2023. Fifty eight percent occurred in females compared to only 42% in males, making females 1.4 times more likely to experience injury. Most injuries took place in 2017. Most cases in adolescents were aged 15 and 14 years old. The 10-19 age group had disproportionately more cases. 1,067 reported cases of strain/sprains were associated with female patients with 733 cases present in males. Strain/sprains ranked the highest, followed by fractures, excluding other/not stated cases. The ankle was the body part with the most cases, followed by injury to the knee. Conclusions As a widely popular sport, future studies should look at providing a more comprehensive characterization into how a patient’s specific demographics may play into injury detection and prevention.

The Association Between Kinesiophobia and Self-Esteem Among Collegiate Athletes with Chronic Lower Extremity Musculoskeletal Injuries in Greater Manila: A Cross-Sectional Analytical Study Protocol

The Association Between Kinesiophobia and Self-Esteem Among Collegiate Athletes with Chronic Lower Extremity Musculoskeletal Injuries in Greater Manila: A Cross-Sectional Analytical Study Protocol

Soulful Rhythm, Dancing Bodies: Spirituality, Pain Tolerance, and the Risk of Lower Extremity Musculoskeletal Injuries Among Classical Kathak Dancers of India

Background: Dance and dancers reflect happiness, sadness, passion, anger, and all other emotions as every single dancing movement carries a significant signal that goes beyond words. Kathak, an Indian classical dance form, requires a divine balance between the soul and the physical body. This balance allows for a high pain tolerance of the dancers, but the spiritual nature of this dance form also generates ignorance and disinterest in their health seeking behavior towards injuries. Objectives: This comprehensive narrative review is aimed at exploring and examining the prevalence of lower extremity musculoskeletal injuries among Kathak dancers and proposes management strategies for their prevention and treatment. Methods: This review is based on a search of relevant articles, research papers, books and book chapters conducted across a wide array of online sources, utilizing the search engines like PubMed, Medline, CrossRef; etc. Considering the inclusion criterion, the review process included three stages: initial assessment of papers through title and abstract review, a detailed examination of relevant items, and systematic compilation of pertinent information into a categorized table under topical headings. Results: The review finds that the majority of injuries were reported in the foot and ankle region of dancers practicing Kathak. Conclusion: There is a need to develop supplementary exercise training programs and also spread awareness among dancers regarding their physical health and seeking medical care in time to delay/prevent lower extremity injuries.

Interrater Reliability of Performing a Step-by-Step Procedure for Selected Pain Provocation Tests for Hamstrings and Special Tests for Other Lower Extremity Musculoskeletal Injuries

Objective: Our study aims to establish interrater reliability in performing the step-by-step procedure of selected pain provocation tests for hamstrings and special tests for lower extremity musculoskeletal injuries. Study Design : An interrater reliability study Setting: University of Santo Tomas - Sports Science Laboratory Participants: Ten healthy adults (five females, five males; age = 22.2 ± 0.42) from the university community. Main Outcome Measures: Interrater reliability of performing step-by-step procedures for selected pain provocation tests for hamstrings (painful resisted knee flexion 90°, painful resisted knee flexion 30°, active slump test, Puranen-Orava Test, bent knee stretch) and special tests for lower extremity musculoskeletal injuries (Lachman’s test, McMurray’s test, posterior drawer test, valgus, and varus stress test). Results: Fleiss kappa showed perfect agreement (κ = 1.00) for all test procedures except for Lachman’s test procedure 1 (κ= -0.11 [95% CI, -0.36 to 0.14]), active slump test procedure 4 (κ= -0.03 [95% CI, -0.28 to 0.23]), active slump test procedure 5 (κ= -0.11 [95% CI, -0.28 to 0.23]), and active slump test procedure 6 (κ= -0.05 [95% CI, -0.31 to 0.20]), which resulted in negative agreements. Conclusions: The researcher developed protocols for each special and provocative test were consistent in measuring the intended procedures, and the raters were generally consistent with their ability to measure these tests. Keywords: Interrater reliability, special tests, pain provocation tests, lower extremity injuries

OCCURRENCE OF LOWER EXTREMITY MUSCULOSKELETAL INJURIES DURING THE LOCKDOWN IN ATHLETES

Background of the Study: Lockdown was implemented worldwide to limit the spread of COVID-19. This sudden implementation of lockdown causes significant lifestyle changes for every individual. Along with the general population, it also has psychological, behavioral, and physical consequences on athletes. The study objective is to determine the occurrence of lower extremity musculoskeletal injuries during the COVID-19 lockdown in athletes. Methodology: Retrospective cross-sectional study design was used, and participants were recruited by a non-probability convenient sampling technique. A sample size of 147 was taken as calculated by the Raosoft software, and the study was completed 6 months. Both male and female athletes between the age group of 18-35 years, participants who did not participate in any official training session during the lockdown and registered at domestic level for at least 2 years were recruited from Pakistan Sports Board and Wapda Sports Complex Lahore. Data was collected using a semi-structured questionnaire. Nordic Musculoskeletal Questionnaire was used to identify the problematic painful areas of body. Data entry, analysis, and interpretation were done by using SPSS software version 22.0. Results: The mean age and BMI of participants were 25.6531±4.49 (years) and 23.28±3.24 (kg/m2) respectively. From the total, 39.5% of participants reported lower extremity musculoskeletal injuries. And most reported problematic areas include lower back and knee. 75% of participants continue to do workouts at home as a prevention strategy against injury occurrence. Conclusion: This concluded that the occurrence of lower extremity musculoskeletal injuries during the lockdown was moderate. Keywords: Athletes, COVID-19, lockdown, lower extremity, lower limb, quarantine, SARS-CoV.

Differences in running biomechanics between young, healthy men and women carrying external loads.

During U.S. Army basic combat training (BCT), women are more prone to lower-extremity musculoskeletal injuries, including stress fracture (SF) of the tibia, with injury rates two to four times higher than those in men. There is evidence to suggest that the different injury rates are, in part, due to sex-specific differences in running biomechanics, including lower-extremity joint kinematics and kinetics, which are not fully understood, particularly when running with external load. To address this knowledge gap, we collected computed tomography images and motion-capture data from 41 young, healthy adults (20 women and 21 men) running on an instrumented treadmill at 3.0m/s with loads of 0.0kg, 11.3kg, or 22.7kg. Using individualized computational models, we quantified the running biomechanics and estimated tibial SF risk over 10weeks of BCT, for each load condition. Across all load conditions, compared to men, women had a significantly smaller flexion angle at the trunk (16.9%-24.6%) but larger flexion angles at the ankle (14.0%-14.7%). Under load-carriage conditions, women had a larger flexion angle at the hip (17.7%-23.5%). In addition, women had a significantly smaller hip extension moment (11.8%-20.0%) and ankle plantarflexion moment (10.2%-14.3%), but larger joint reaction forces (JRFs) at the hip (16.1%-22.0%), knee (9.1%-14.2%), and ankle (8.2%-12.9%). Consequently, we found that women had a greater increase in tibial strain and SF risk than men as load increases, indicating higher susceptibility to injuries. When load carriage increased from 0.0kg to 22.7kg, SF risk increased by about 250% in women but only 133% in men. These results provide quantitative evidence to support the Army's new training and testing doctrine, as it shifts to a more personalized approach that shall account for sex and individual differences.

Effects of short foot exercise on Q-angle in individuals with flatfoot

Background: Flatfoot is a predominant chronic condition associated with lower extremity musculoskeletal injuries. Current studies have illustrated that a flatfoot deformity may result in an increased Q-angle which can cause knee disorders. Short foot exercise (SFE) is a broadly acknowledged strategy for strengthening the intrinsic foot muscles. The exercise is recommended to be performed to improve the medial longitudinal arch (MLA). However, there is a lack of studies examining the effects of SFE on the Q-angle. Objectives: The primary purpose of this study was to investigate the effects of SFE on Q-angle in individuals with flatfoot. The second purpose was to examine the effects of SFE on the navicular drop test (NDT). Materials and methods: This randomized controlled trial study included 16 participants aged 18-25 years with flexible flatfoot on both feet based on the results of NDT. Q-angle and NDT were measured at the beginning of the study. The participants were randomly assigned to either the experimental or control groups. The experimental group performed SFE three days a week for five consecutive weeks, while the control group did not perform the exercise. Q-angle and NDT were reassessed after five weeks of the exercise. Results: Q-angle significantly decreased in the exercise group after the program for both legs (Right leg: from 21.62±1.87 to 19.83±1.63 degrees; Left leg: from 21.42±1.92 to 20.04±1.89 degrees). In addition, NDT significantly improved in the exercise group after SFE for both feet (Right foot: from 11.08±1.18 to 6.83±2.09 mm; Left foot: from 10.58±1.50 to 6.58±1.60 mm). Conclusion: This present study demonstrated that SFE effectively improved Q-angle and NDT in individuals with flexible flatfoot.

Reactive postural responses predict risk for acute musculoskeletal injury in collegiate athletes.

Examine if objective assessments of reactive postural responses, quantified using wearable inertial measurement units, are associated with the risk for acute lower extremity musculoskeletal injuries in collegiate athletes. Prospective survival analysis. 191 Division I National Collegiate Athletic Association athletes completed an instrumented version of a modified Push and Release (I-mP&R) test at the beginning of their competitive season. The I-mP&R was performed with eyes closed under single- and dual-task (concurrent cognitive task) conditions. Inertial measurement units recorded acceleration and angular velocity data that was used to calculate time-to-stability. Acute lower extremity musculoskeletal injuries were tracked from first team activity for six months. Cox proportional hazard models were used to determine if longer times to stability were associated with faster time to injury. Longer time-to-stability was associated with increased risk of injury; every 250 ms increase in dual-task median time-to-stability was associated with a 36% increased risk of acute, lower-extremity musculoskeletal injury. Tests of reactive balance, particularly under dual-task conditions, may be able to identify athletes most at risk of acute lower extremity musculoskeletal injury. Clinically-feasible, instrumented tests of reactive should be considered in assessments for prediction and mitigation of musculoskeletal injury in collegiate athletes.

Lower Extremity Musculoskeletal Injuries After Concussion in Collegiate Student-Athletes

Background: An association has been identified between concussion and lower extremity musculoskeletal injury (LEMSKI) after return to sports participation. However, the collegiate student-athlete studies have relied on relatively small single-institution studies, which limits generalizability. Purpose: To assess odds of, and time to, LEMSKI after concussion in US collegiate athletes, using the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP). Study Design: Descriptive epidemiology study. Methods: Data from the NCAA ISP during the 2010-2011 through 2019-2020 athletic seasons were considered for analysis. Frequency distributions were examined for details related to the initial and subsequent injuries (injuries to bone, bursa, joint, ligament, muscle, or tendon). Multivariable logistic regression models and random-effects Poisson regression models examined odds of time loss (TL) and non–time loss (NTL) LEMSKI after concussion, as well as the time interval between initial concussion and subsequent LEMSKI in a single athletic season, or initial musculoskeletal injury (MSKI) and subsequent LEMSKI in a single athletic season. Analyses were performed separately for football and other sports. Results: A total of 31,556 initial injuries were recorded (football: 11,900; other sports: 19,656), which were followed by 0 or 1 injury in the same season. Overall, first injury type was not a significant predictor of subsequent LEMSKI, although certain contrasts yielded significant estimates. In football, the odds of NTL LEMSKI were higher after concussion than after upper extremity MSKI (UEMSKI; adjusted odds ratio [ORAdj], 1.56; 95% CI, 1.06-2.31). In football, the odds of TL LEMSKI were lower after concussion than after UEMSKI (ORAdj, 0.71; 95% CI, 0.51-0.99). No other significant effect estimates were observed for football or other sports. Conclusion: First injury type, either concussion or upper extremity, was not associated with an elevated risk of LEMSKI. Specifically, the results of this study did not identify an elevated odds of LEMSKI after a concussion. However, the authors observed greater odds of NTL LEMSKI and lower odds of TL LEMSKI in football.

Postural balance asymmetry and subsequent noncontact lower extremity musculoskeletal injuries among Tunisian soccer players with groin pain: A prospective case control study

BackgroundRecent studies reported postural balance disorders in patients and soccer players with groin pain (GP) compared to controls. Since postural balance asymmetry identified after an initial injury contributes for subsequent injuries, identification of this asymmetry in soccer players with GP may highlight the risk of sustaining subsequent noncontact lower extremity musculoskeletal injuries in these players. Therefore, the aims of this study were to (i) examine static and dynamic unipedal postural balance asymmetry in soccer players with GP compared to healthy ones, and (ii) quantify the risk of subsequent noncontact lower extremity injuries in these players. Research questionDo soccer players with GP exhibit higher static and dynamic unipedal postural balance asymmetry, and higher risk of sustaining subsequent injuries compared to controls? MethodsIn this prospective case control study, 27 soccer players with non-time loss GP (GP group: GPG), and 27 healthy ones (control group: CG) were enrolled. Static and dynamic unipedal postural balance asymmetry were evaluated with a force platform using symmetry index (SI), and Y-balance test (Y-BT), respectively. Additionally, subsequent noncontact lower extremity musculoskeletal injuries were tracked for 10 months. ResultsThe GPG revealed higher (p < 0.01) SI in eyes closed condition, higher (p < 0.001) side-to-side asymmetry in anterior, posteromedial and posterolateral reach distances and in composite Y-BT score compared to CG. They showed lower (p < 0.001) composite score for injured limb and higher (p < 0.001) side-to-side asymmetry in posteromedial reach distance compared to the cut-off values of 89.6 % and 4 cm, respectively. Moreover, GPG exhibited higher odds (OR= 7.48; 95 % CI = 2.15, 26.00; p < 0.01) of sustaining subsequent injuries compared to CG. SignificanceThe Y-BT should be instituted into existing pre-participation physical examinations to screen for soccer players with non-time loss GP at an elevated risk of sustaining subsequent injuries. This could help coaches and clinicians make valid return to play decisions.

Prevention of Lower Extremity Musculoskeletal Injuries in Tactical and First Responder Populations: A Systematic Review and Meta-Analysis of Randomized Trials From 1955 to 2020.

Sinnott, AM, Krajewski, KT, LaGoy, AD, Beckner, ME, Proessl, F, Canino, MC, Nindl, BC, Turner, RL, Lovalekar, MT, Connaboy, C, and Flanagan, SD. Prevention of lower extremity musculoskeletal injuries in tactical and first responder populations: A systematic review and meta-analysis of randomized trials from 1955 to 2020. J Strength Cond Res 37(1): 239-252, 2023-Lower extremity musculoskeletal injuries (LEMSIs) impose a significant burden on tactical and first responder populations. To determine the effectiveness of LEMSI prevention strategies, we performed a systematic review and meta-analysis of randomized controlled trials published in English from 1955 to 2020 (PROSPERO: CRD42018081799). MEDLINE, EMBASE, Cochrane, CINAHL, ProQuest, and DTIC databases were searched for trials that assigned military service members, police, firefighters, or paramedics to LEMSI prevention interventions with a minimum surveillance period of 12 weeks. Evidence was synthesized as odds ratios (OR) for LEMSI occurrence between individuals assigned to interventions and those assigned to standard activities. Risk of bias was assessed with the Cochrane Risk of Bias tool 2.0. Random-effects meta-analyses were conducted for (a) physical training and (b) footwear modifications to reduce LEMSI and (c) footwear modifications to reduce stress fractures specifically. Certainty in the body of evidence was determined with the GRADE approach. Of 28,499 records, 18 trials comprised of more than 11,000 subjects were synthesized. Interventions included physical training (8, N = 6,838), footwear modifications (8, N = 3,792), nutritional supplementation (1, N = 324), and training modifications (1, N = 350). Overall risk of bias was generally moderate ( N = 7 of 18) or high ( N = 9 of 18). Physical training (OR = 0.87, 95% CI [0.71, 1.08], p = 0.22, I 2 = 58.4%) and footwear modification (OR = 1.13, 95% CI [0.85, 1.49], p = 0.42, I 2 = 0.0%) did not reduce LEMSI or stress fractures (OR = 0.76, 95% CI [0.45, 1.28], p = 0.30, I 2 = 70.7%). Our results indicate that there is weak evidence to support current LEMSI prevention strategies. Future efforts will benefit from longer surveillance periods, assessment of women and nonmilitary populations, improved methodological rigor, and a greater breadth of approaches.

Concussion is not associated with elevated rates of lower-extremity musculoskeletal injuries in National Football League Players

ABSTRACT Objective Emerging evidence has identified an ~2x elevated risk of musculoskeletal (MSK) injury in the year following a concussion. Most of these studies have examined a single college/university athletic department and may lack generalizability to professional sports. Therefore, the purpose of this study was to assess the odds of post-concussion MSK injury utilizing publicly available National Football League (NFL) injury reports. Methods Concussions were identified through a review of published NFL injury reports during the 2015, 2016, and 2017 regular seasons. Concussed players were matched by team and position, and injuries were tracked for both groups for the remainder of the season. A chi-square analysis compared the frequency of MSK injury in both groups and a Cox Proportional Hazard model calculated the risk of sustaining a subsequent MSK injury. Results There were 322 concussed NFL players who met inclusion criteria and were successfully matched. From the time of concussion through the remainder of the season, 21.4% of the concussed players were injured and 26.4% of control participants were injured. There was no difference in MSK injury rates (p = 0.166), and the relative risk ratio was 0.90 for subsequent injury in the concussion group. There was no difference in the time to event for subsequent MSK between the two groups (p = 0.123). Conclusion The primary finding of this study was no elevated risk of post-concussion MSK in NFL football players.

Plantar loads characteristics of male non-rearfoot strikers running on different overground surfaces at preferred speed

Background: This study aimed to investigate the plantar loads of male non-rearfoot strike runners running on different overground surfaces at their preferred speeds. Methods: A total of 32 male runners with non-rearfoot strike were required to run for 15 m on concrete, synthetic rubber and grass surfaces at their preferred speeds. An insole sensor system was used to determine the runners’ foot strike pattern and measure peak pressure, pressure-time integral, maximum force, force-time integral and contact area of the total foot and nine selected foot regions. Results: No significant differences on their preferred speeds were observed running on concrete, synthetic rubber and grass surfaces. No significant differences on plantar loads parameters of the total foot were found when running on the three overground surfaces. Running on concrete showed higher peak pressure in the lateral forefoot compared with grass and synthetic rubber (283.49 kPa vs. 264.31 kPa, P &lt; 0.023; 283.49 kPa vs. 263.18 kPa, P &lt; 0.019, respectively). Maximum force in the medial forefoot was lower when running on concrete compared with grass and synthetic rubber (40.16 %BW vs. 42.52 %BW, P &lt; 0.042; 40.16 %BW vs. 43.21 %BW, P &lt; 0.022, respectively). Conclusions: Repetitive and excessive plantar loads during long-distance running may result in loads-related injury in lower extremity skeletal tissues for non-rearfoot runners at preferred speeds. Therefore, male non-rearfoot strikers should choose the appropriate overground surface to reduce the risk of lower extremity musculoskeletal injuries.

Lower Extremity Splinting: A Head-to-Head Comparison of A Novel One-Step Spray-on Splint Versus Standard Splinting.

Splinting is an essential component of treating many lower extremity musculoskeletal injuries; however, little development has been made in splinting technology. The purpose of this study is to evaluate the efficacy of current immobilization equipment for lower extremity fractures by testing a novel one-step spray-on foam splint (Fast Cast) against structural aluminum malleable (SAM) lower extremity musculoskeletal injuries and 6-inch ACE (3M Corp., Minneapolis, MN, USA) bandage splints. Six orthopedic surgical residents and two medical students participated in a prospective analysis of austere splinting techniques and equipment that utilized a cadaveric model with a distal third tibia-fibula shaft fracture. Each participant was observed and scored by three fellowship trained attending orthopedic surgeons. All scoring was independent using a 5-point Likert scale based on 10 splinting criteria (50 total points possible), including quality of radiographic reduction, time to completion, safety, and sustain longitudinal traction. The Likert scale is a set of questions that reflects the respondent's degree of agreement or disagreement with a statement. Each of the 10 questions has a range of 1-5. A score of 50 means the splint performed perfectly. The lowest possible score is a 10. The participants utilized standard equipment that included SAM splints and 6-inch ACE wraps (3M Corp., Minneapolis, MN, USA) in their first attempt. A second immobilization attempt was done with a one-step spray-on foam splint (Fast Cast). After each splinting attempt, the reduction was verified with radiographic imaging. Data analysis was performed using standard descriptive statistics, Student's t-tests, and inter-rater reliability was calculated using Cronbach's alpha scores. This project is Institutional Review Board (IRB) exempt. The one-step spray-on foam splinting technique was superior (P < .05) in all parameters of the Likert scale, yielding a mean overall score of 45.1 points (±3.8), safety 4.7 points, longitudinal traction 4.5 points, and time 136 seconds (±23). The SAM resulted in a mean overall score of 33.8 points (±7.3), safety 2.8 points, longitudinal traction 4.1 points, and time 170 seconds (±52). Radiographic rating was 4.1 points (±0.7) for the SAM splint and 4.5 (±0.6) for Fast Cast. The differences in time to completion and radiograph rating did not reach statistical significance (P = .12 and P = .07, respectively). A one-step spray-on foam splinting technique demonstrated consistent superiority in reducing fracture motion, potential soft-tissue damage, and sustained longitudinal traction as compared to the standard technique.

Elevated Kinesiophobia Is Associated With Reduced Recovery From Lower Extremity Musculoskeletal Injuries in Military and Civilian Cohorts.

The purpose of this study was to examine associations between level of kinesiophobia and improvement in physical function during recovery from lower extremity injury. A total 430 adults (mean [SD]: age = 27.3 [6.4] years; sex = 70.5% men; body mass index = 27.6 [5.2] kg/m2) were included in the analyses. Using the Patient-Reported Outcomes Measurement Information System, physical function was evaluated in parallel with treatment from a physical therapist at the initial visit and every 3weeks until final visit or up to 6months. A Tampa Scale of Kinesiophobia (TSK-17) score of >41 indicated elevated TSK. Four TSK groups were identified: (1) TSK score improved from >41 at initial visit to <41 by final visit (TSK_I), (2) TSK score was <41 at initial and final visits (TSK-), (3) TSK score was >41 at initial and final visits (TSK+), and (4) TSK score worsened from <41 at initial visit to ≥41 by final visit (TSK_W). Linear mixed effects models were used to examine differences between groups in improved physical function over time, with adjustment for depression and self-efficacy. Groups with elevated kinesiophobia at the final visit had smaller positive improvements in physical function (mean change [95% CI]: TSK+ = 7.1 [4.8-9.4]; TSK_W: 6.0 [2.6-9.4]) compared with groups without elevated kinesiophobia at the final visit (TSK_I = 9.8 [6.4-13.3]; TSK- = 9.7 [8.1-11.3]) by 12 weeks. Elevated kinesiophobia that persists or develops over the course of care is associated with less improvement in physical function within military and civilian cohorts. The findings of this prospective longitudinal study support the need to assess for elevated kinesiophobia throughout the course of care because of its association with decreased improvement in physical function. To help improve your physical function, your physical therapist can monitor the interaction between fear of movement and your clinical outcomes over the course of treatment.

A Narrative Review Evaluating Extracorporeal Shockwave Therapy as a Potential Regenerative Treatment for Musculoskeletal Conditions in Military Personnel

Extracorporeal shockwave therapy (ESWT) has a wide variety of clinical applications ranging from urology to orthopedics. Extracorporeal shockwave therapy is of particular interest to military medicine in the treatment of diverse musculoskeletal injuries, including recalcitrant tendinopathy. Much of the evidence for ESWT is from studies in the civilian population, including athletes. A few investigations have been conducted within military personnel. Musculoskeletal conditions within military personnel may contribute to pain and physical limitations. Optimal functional outcomes could be achieved through ESWT. The purpose of this narrative review is to summarize the current evidence on the efficacy of ESWT the in management of lower extremity musculoskeletal injuries in the military. Further, we explore the relative efficacy of ESWT compared to regenerative medicine procedures, including studies with treatment using platelet-rich plasma. A literature review was performed in April 2020 to identify studies evaluating the use of ESWT for lower extremity conditions commonly observed in military personnel, including plantar fasciitis, Achilles tendinopathy, patellar tendinopathy, medial tibial stress syndrome, and knee arthritis. The literature search was completed by two researchers independently, using PubMed and Embase databases and same search terms. Disagreements were adjudicated by a senior author. Due to the paucity of relevant search results, the search term parameters were expanded to incorporate active participants. Two studies evaluated the use of ESWT in a military population for lower extremity injuries. This included a randomized control trial in active military with medial tibial stress syndrome and an unblinded retrospective study for the chronic plantar fasciitis condition. Both studies in the military had favorable outcomes in the use of ESWT compared to other treatment arms. The remaining studies predominantly included athletes. Although heterogeneity on the quality of the studies may prevent meta-analysis and limit the generalization of the findings, the majority of studies demonstrated an improvement in pain and return to activity using ESWT. Two studies using platelet-rich plasma as a treatment arm identified similar short-term outcomes compared to ESWT for Achilles tendinopathy and patellar tendinopathy. Our findings suggest that ESWT is a safe and well-tolerated intervention with positive outcomes for lower extremity conditions commonly seen in the military. The few studies comparing ESWT to PRP suggest regenerative benefits similar to orthobiologics in the shorter term. More robust quality designed research may enable the evaluation of ESWT efficacy within the military population. In summary, the use of ESWT may provide pain reduction and improved function in active populations with lower extremity musculoskeletal injuries. Further research in the military is needed to evaluate shockwave efficacy in order to advance musculoskeletal care and improve outcomes.

Profiling lower extremity injuries sustained in a state police population: a retrospective cohort study

BackgroundTactical populations, such as military, firefighter and law enforcement populations, are known to suffer a relatively high number of musculoskeletal injuries, with the lower extremity of notable concern. The aim of this retrospective cohort study was to determine the profile of lower extremity musculoskeletal injuries within a state police agency.MethodsInjury data were collected by an Australian state police force over a 7-year period (2009–2016) and records not meeting the definition for lower extremity musculoskeletal injury were excluded. Statistical analyses were descriptive, with frequencies, means and standard deviations calculated where applicable. Chi-square analysis was performed to compare injury profiles by gender. Ethics approval was granted by Bond University Human Research Ethics Committee (Research Protocol 15360).ResultsOf the initial 65,579 incident records, 12,452 (19%) related to lower extremity musculoskeletal injuries. The knee was the most commonly injured site (31.4%) with sprains/strains (42.3%) the most common nature of injury and arresting offenders (24.2%) the most common activity at time of injury. Slips/trips/falls (37.8%) was found to be the most common cause of injury. Variations were found between genders, most notably within the injury activity (p < .001). 27.1% of male officers were injured when arresting offenders compared to 16.5% for female officers. Walking/running contributed to 17.9% of female officer incidents compared to 9.3% for male officers. The mean number of hours worked prior to injury occurrence was 6.00 ± 3.56 h with significantly more injuries occurring in the middle third of the shift (4.34–8.67 h, p < 0.001).ConclusionsWhile the proportion of injuries that affected the lower extremity was lower for police, the leading sites of injuries (knees and ankles) were similar to those of military and fire and rescue populations. Variations between genders suggest there may need to be differences in return-to-work rehabilitation.